A practical guide to exercise training for heart failure patients

Background: Exercise training has been shown to improve exercise capacity in patients with heart failure. We sought to examine the optimal strategy of exercise training for patients with heart failure. Methods: Review of the published data on the characteristics of the training program, with comparison of physiologic markers of exercise capacity in heart failure patients and healthy individuals and comparison of the change in these characteristics after all exercise training program. Results: Many factors, including the duration, supervision, and venue of exercise training; the volume of working muscle; the delivery mode (eg, continuous vs. intermittent exercise), training intensity; and the concurrent effects of medical treatments may influence the results of exercise training in heart failure. Starting in an individually prescribed and safely monitored hospital-based program, followed by progression to an ongoing and progressive home program of exercise appears to be the best solution to the barriers of anxiety, adherence, and ease of access encountered by the heart failure patient. Conclusions: Various exercise training programs have been shown to improve exercise capacity and symptom status in heart failure, but these improvements may only be preserved with an ongoing maintenance program.

Testamentary capacity and aphasia: A descriptive case report with implications for clinical practice

Background: Testamentary capacity (the capacity to make a will) is recognised in the literature as an important issue for speech-language pathologists' assessment of people with aphasia, but current guidelines for clinical practice lack an empirical base. Aims: The research aimed to suggest some guidelines for clinical practice based on information considered relevant for the court in determining testamentary capacity. Methods & Procedures: A recent legal case involving a challenge to the will of a woman with severe aphasia was critically examined with reference to current guidelines in the literature regarding assessment of testamentary capacity. Outcomes & Results: Examination of the information available on the case indicated that the judge gave priority to accounts of the everyday communication of the person with aphasia (including reported discourse samples) over the information provided by expert medical witnesses. The extent to which communication effectiveness could be maximised was found to be a matter of key significance to the determination of capacity. Conclusions: This study has implications for speech-language pathologists' assessment practices and reports, as well as for scope of practice with regard to legal decision making of people with aphasia. These issues are discussed in relation to the World Health Organisation's ICF framework of functioning for social participation.

Mechanisms of exercise training in patients with heart failure

Background The reduction of exercise capacity because of fatigue and dyspnea in patients with heart failure can be improved with exercise training. We sought to examine the mechanisms of exercise training, as an adjunctive treatment strategy for patients with heart failure. Methods a reviewed the published data on the possible mechanisms of effect of exercise training in heart failure. Results Symptoms of heart failure may be explained on the basis of abnormal skeletal muscle perfusion and structure and endothelial function. Exercise training has been shown to engender changes in muscle structure and biochemistry and vascular function, although effects on cardiac function have not been detected uniformly and may require longer training periods. Conclusions A suitable, long-term program of exercise training may reverse unfavorable interactions among the heart, vessels, and skeletal muscles. These improvements may be preserved with an ongoing maintenance program.

Matriz de capacita????o modelada por compet??ncias para atuar em programas de educa????o a dist??ncia: uma proposta para as escolas de governo

This study discusses distance learning (DL) as a corporate education strategy in the scope of National Policy on Staff Development. The purpose was to identify, along with managers and specialists of National Network of Schools of Government in Brazil (RNEG), demanded competencies for DL professionals acting in continued education to service public. Part of the research is based in official documents and in related capacity-building initiatives of Schools of Government in the last three years. Through questionnaire sent to managers of institutions of RNEG, we identified existing infrastructure, teams profile, actions developed in DL and training needs. The research allowed to map the critical competencies to work in DL programs and to create a proposal from a Competency-Based Training Matrix for school teams in order to leverage continuing education programs to public servants in three spheres of government. The results revealed the key technological, pedagogical, management and communication skills, as well as the critical activities and content to be included in the training plans. It was found that 88% of institutions have already implemented or are in the process of implementing DL, and the other 12% are deficient in qualified staff to make regulations on hiring personnel or in technology fluency. This corroborates the importance and the contribution of Competency-Based Training Matrix for RNEG

A presta????o pelo setor p??blico n??o estatal dos servi??os de sa??de p??blica: an??lise de hip??teses e potencialidades

O trabalho analisa a potencialidade do desenvolvimento de alian??as entre o p??blico e o privado na gest??o p??blica municipal brasileira da sa??de. A relev??ncia da quest??o pauta-se na transfer??ncia de responsabilidade da presta????o de servi??os de sa??de para os munic??pios, posterior ?? promulga????o da Constitui????o Federal, aliada ?? limita????o da capacidade de gest??o dos mesmos. As an??lises aqui tratadas referem-se ??s alian??as previstas no arcabou??o legal brasileiro, estabelecidas entre o ente p??blico e o terceiro setor. Essas alian??as s??o introduzidas pela reforma do aparelho do Estado, em 1995, no ??mbito da qual se utilizou a estrat??gia de publiciza????o que tratou do fortalecimento dessa alian??a entre o Estado e o Terceiro Setor. A partir dos modelos poss??veis de parcerias com o terceiro setor, este estudo apresenta uma an??lise do modelo das organiza????es sociais (OS), trazendo ?? luz estrat??gias e desafios para sua implementa????o.

Trichogramma acacioi (Hymenoptera, Trichogrammatidae) parasitism capacity at different temperatures and factitious hosts

It was studied the parasitism capacity of Trichogramma acacioi on Anagasta kuehniella and Sitotroga cerealella eggs at different temperatures (15, 20, 25, 30 and 35 ± 1°C). The parasitism of T. acacioi varied with temperature and host. The highest parasitism (³80%) were observed during the first days after emergence in both hosts, at all tested temperatures. The accumulated parasitism varied with both host and temperature, being higher on A. kuehniella at 20°C, what shows good parasitoid species adaptation to this temperature. Thus, we conclude that the best host and best temperature to be used at mass-rearing of T. acacioi is A. kuehniella and 20ºC, respectively. Moreover, this Trichogramma species has great potential to be used in field releases at regions where average temperature is around 20ºC.

Brazil: an emerging military power? The problem of the use of force in Brazilian international relations in the 21st century

The central goal of this paper is thinking about the Brazilian military power and its linking to the international ambitions of the country in the 21st century. After a comparative analysis to other BRICs and with a historical one about Brazil's strategic irrelevance, we aim to establish what the minimum military capacity Brazil would need in order to meet the country's latest international interests. Similarly, it will be discussed if the National Strategy of Defense, approved in 2008, and the recent strategic agreements signed with France represent one more step toward this minimum military capacity.

Rio Branco, grand strategy and naval power

This article addresses Baron of Rio Branco's grand strategy and the role played by the naval reorganization program (1904-1910) in this context. The ensuing case study determined the domestic and international constraints that affected the program, as well as the worldview of the patron of Brazilian diplomacy regarding military power's instrumentality to foreign policy.

Swords into ploughshares? China's Soft Power strategy in Southeast Asia and its challenges1

Since the 1990s, alongside China's economic growth, the international community has fostered a general anxiety towards a "China threat." In order to relieve itself from suspicion, China adopted the dual strategies of "harmonious worldview" and "good neighbor policy." The strategies led to the use of soft power in China's foreign policy. China aimed to reduce security concerns implied by the threat theory by supporting an image that caters to international peace and development. This article seeks to explain how China achieves its interests in Southeast Asia through the use of soft power. The authors address the concepts of "harmonious worldview" and "good neighbor policy" and how the twin strategies and soft power have shaped China's foreign policy in recent years. This article aims to provide insights into China's policy options in Southeast Asia in the near future.

Portugal’s Minho-Lima region as a tourist destination: tourism operators’ attitudes towards its management and promotion

The success of tourism development depends on the capacity of a region’s tourism agents to establish and sustain networks, involving both private-sector companies and the public sector. Creating an attractive destination able to compete with others that are better positioned and consolidated requires cooperative behaviour among the various agents involved. This behaviour will facilitate both external and internal competition, which in turn will assure better product quality, continuous product renewal, a strong offer of unique experiences and the efficient use of endogenous resources. In this paper, the authors discuss the results of a survey of restaurant owners and of interviews conducted with the main institutional agents concerned with tourism promotion and the economic development of the Minho–Lima region. Such an approach, the authors argue, can be valuable in identifying the strengths and weaknesses of the area in question with regard to future tourism development. The authors work from the premise that the commitment of tourism agents constitutes a precondition for the success of the strategy to be defined. This is especially applicable to Minho–Lima, which to date has suffered from an absence of commitment and coordination on the part of those agents.